The principal investigator (PI) is currently funded by a K12 Mentored Clinical Scientist Development Program Award through the Duke University Eye Center. The proposed K23 Career Development Award will provide continued mentored training to assist the PI to become an independent clinician-scientist by the end of the award period. The PI has identified a strong and diverse group of mentors in the field of retinopathy of prematurity (ROP), biomedical engineering, and telemedicine to ensure that the objectives of her research and career development program will be achieved. The PI will also continue to receive didactic training in clinical research. The PI's long-term career goal is to become an independent clinician-scientist focused on adapting innovative strategies to improve access to care and outcomes in underserved communities. Her clinical training and previous work in public health have prepared her to take on the challenges proposed in this career development plan and research proposal. Environment: Duke University and the Duke University Eye Center are superb environments that are well situated to support and nurture the next generation of clinician-scientists. They have the resources, facilities, faculty, and track record of training an supporting successful clinician-scientists. Research Summary: ROP is the leading preventable and treatable cause of blindness in children in the United States.1 While appropriate screening and treatment could reduce the burden of childhood blindness from ROP, an important barrier to effective ROP screening is the shortage of ophthalmologists skilled in ROP screening.2 Thus, alternative methods to screen for ROP are needed. The focus of this proposal is to evaluate a new, FDA-approved, portable, non-contact digital fundus camera, Pictor, for ROP screening. To evaluate the feasibility of using Pictor as an ROP screening tool, we will evaluate the following specific aims: (1) the feasibility of having trained non-ophthalmologist health care workers (HCWs) obtain high-quality Pictor images of the retina of prematurely-born infants at risk for ROP and (2) the accuracy and reliability of grading these Pictor images for clinically-significant posterior pole disease compared to the reference standard of indirect ophthalmoscopy. Non-ophthalmologist HCWs will be trained to acquire images on prematurely-born infants using the Pictor camera during routine weekly ROP rounds in the neonatal intensive care unit. We will evaluate HCW's ability to obtain high-quality images and explore the accuracy of grading these images for clinically-significant posterior pole disease compared to the clinical exam findings obtained on the same day using indirect ophthalmoscopy by a skilled ophthalmologist. The results of this study will offer alternative screening methods for ROP and increase our scope of imaging techniques for use in telemedicine. Our long-term objective is to increase access for ROP screening to those in rural or remote areas to decrease the burden of blindness due to untreated ROP.